Collagen synthesis in cells cultured from v. Recklinghausen's neurofibromatosis

snRNA-seq of human cutaneous neurofibromas before and after selumetinib treatment implicates role of altered Schwann cell states, inter-cellular signaling, and extracellular matrix in treatment response

Neurofibromatosis Type 1 (NF1) is caused by loss of function variants in the NF1 gene. Most patients with NF1 develop skin lesions called cutaneous neurofibromas (cNFs). Currently the only approved therapeutic for NF1 is selumetinib, a mitogen -activated protein kinase (MEK) inhibitor. The purpose of this study was to analyze the transcriptome of cNF tumors before and on selumetinib treatment to understand both tumor composition and response. We obtained biopsy sets of tumors both pre- and on- selumetinib treatment from the same individuals and were able to collect sets from four separate individuals. We sequenced mRNA from 5844 nuclei and identified 30,442 genes in the untreated group and sequenced 5701 nuclei and identified 30,127 genes in the selumetinib treated group. We identified and quantified distinct populations of cells (Schwann cells, fibroblasts, pericytes, myeloid cells, melanocytes, keratinocytes, and two populations of endothelial cells). While we anticipated that cell proportions might change with treatment, we did not identify any one cell population that changed significantly, likely due to an inherent level of variability between tumors. We also evaluated differential gene expression based on drug treatment in each cell type. Ingenuity pathway analysis (IPA) was also used to identify pathways that differ on treatment. As anticipated, we identified a significant decrease in ERK/MAPK signaling in cells including Schwann cells but most specifically in myeloid cells. Interestingly, there is a significant decrease in opioid signaling in myeloid and endothelial cells; this downward trend is also observed in Schwann cells and fibroblasts. Cell communication was assessed by RNA velocity, Scriabin, and CellChat analyses which indicated that Schwann cells and fibroblasts have dramatically altered cell states defined by specific gene expression signatures following treatment (RNA velocity). There are dramatic changes in receptor-ligand pairs following treatment (Scriabin), and robust intercellular signaling between virtually all cell types associated with extracellular matrix (ECM) pathways (Collagen, Laminin, Fibronectin, and Nectin) is downregulated after treatment. These response specific gene signatures and interaction pathways could provide clues for understanding treatment outcomes or inform future therapies.

Metalloproteinase 1 downregulation in neurofibromatosis 1: Therapeutic potential of antimalarial hydroxychloroquine and chloroquine

Neurofibromatosis type 1 is an autosomal dominant genetic disorder caused by mutation in the neurofibromin 1 (NF1) gene. Its hallmarks are cutaneous findings including neurofibromas, benign peripheral nerve sheath tumors. We analyzed the collagen and matrix metalloproteinase 1 (MMP1) expression in Neurofibromatosis 1 cutaneous neurofibroma and found excessive expression of collagen and reduced expression of MMP1. To identify new therapeutic drugs for neurofibroma, we analyzed phosphorylation of components of the Ras pathway, which underlies NF1 regulation, and applied treatments to block this pathway (PD184352, U0126, and rapamycin) and lysosomal processes (chloroquine (CQ), hydroxychloroquine (HCQ), and bafilomycin A (BafA)) in cultured Neurofibromatosis 1 fibroblasts. We found that downregulation of the MMP1 protein was a key abnormal feature in the neurofibromatosis 1 fibroblasts and that the decreased MMP1 was restored by the lysosomal blockers CQ and HCQ, but not by the blockers of the Ras pathway. Moreover, the MMP1-upregulating activity of those lysosomal blockers was dependent on aryl hydrocarbon receptor (AHR) activation and ERK phosphorylation. Our findings suggest that lysosomal blockers are potential candidates for the treatment of Neurofibromatosis 1 neurofibroma.

Neurofibromatosis Type 1: Genetic and Cellular Mechanisms of Peripheral Nerve Tumor Formation

Neurofibromatosis type 1 (NF1) is among the most common inherited human diseases. The NF1 protein is a Ras-GTPase activating protein, positioning NF1 in important intracellular signaling pathways. Patients with mutations in the NF1 gene can develop benign peripheral nerve tumors (neurofibromas), learning disabilities, and/or benign optic nerve gliomas, in addition to abnormalities unassociated with the nervous system. The NF1 gene is believed to act as a tumor suppressor. How NF1 mutations relate to benign features of NF1 is the subject of active investigation. Studies using transgenic mice with NF1 mutations and cells derived from these mice have yielded exciting new data, implicating multiple cell types mutant at NF1 and possibly factors in the environment in the pathogenesis of benign neurofibromas. NEUROSCIENTIST 3:412-420, 1997

Tumors perturbing extracellular matrix biosynthesis. The case of von Recklinghausen's disease

This is a short review of neurofibromatosis-1 or von Recklinghausen's disease, due to a loss of function mutation of the gene neurofibromin-1, which normally inhibits the Ras MAPK-pathways. Among its symptoms, the strong oversynthesis of several collagen types designates this disease as producing a deregulation of extracellular matrix biosynthesis involved in tumor formation. Up to about 40% of the skin tumors consist of collagens. A short summary of the clinical manifestations and pathological and genetic mechanisms are also described.

Survival of Human Neurofibroma in Immunodeficient Mice and Initial Results of Therapy With Pirfenidone

Neurofibromatosis type I is a common tumor predisposing disease in humans. Surgical therapy can be applied only in selected patients with resectable masses. Hence, development of new therapies for this disease is urgent. We used human neurofibroma implants in mice with severe combined immunodeficiency (SCID) as a model to test the toxicity and potential efficacy of pirfenidone, a new therapeutic agent. Two hundred twelve human neurofibromas were transplanted into various locations in 59 experimental animals, and 30 mice with implants received oral pirfenidone for up to six weeks. Survival of neurofibromas in animals treated with pirfenidone was lower than in the control group $(P=.02)$. Tumors did not change histologic appearance or vascularization in response to pirfenidone. Treatment with pirfenidone, a new antifibrotic agent, inhibits survival of some tumors without causing toxicity in animals.

The Nf1 tumor suppressor regulates mouse skin wound healing, fibroblast proliferation, and collagen deposited by fibroblasts

Neurofibromatosis type 1 patients develop peripheral nerve tumors (neurofibromas) composed mainly of Schwann cells and fibroblasts, in an abundant collagen matrix produced by fibroblasts. Trauma has been proposed to trigger neurofibroma formation. To test if loss of the neurofibromatosis type 1 gene (Nf1) compromises fibroblast function in vivo following trauma, skin wounding was performed in Nf1 knockout mice. The pattern and amount of collagen-rich granulation bed tissue, manufactured by fibroblasts, was grossly abnormal in 60% of Nf1+/- wounds. Nf1 mutant fibroblasts showed cell autonomous abnormalities in collagen deposition in vitro that were not mimicked by Ras activation in fibroblasts, even though some Nf1 effects are mediated through Ras. Nf1+/- skin wound fibroblasts also proliferated past the normal wound maturation phase; this in vivo effect was potentiated by muscle injury. In vitro, Nf1+/- fibroblasts showed higher proliferation in 10% serum than Nf1+/+ fibroblasts. Macrophage-conditioned media or epidermal growth factor potentiated Nf1+/- fibroblast proliferation in vitro, demonstrating abnormal response of mutant fibroblasts to wound cytokines. Thus Nf1 is a key regulator of fibroblast responses to injury, and Nf1 mutation in mouse fibroblasts causes abnormalities characteristic of human neurofibromas.

Cell culture studies on human nerve sheath tumors

The main controversy about nerve sheath tumors (NSTs) has been their histogenesis. A Schwann cell origin has been proposed by many investigators for both schwannomas and neurofibromas. However Erlandson and Woodruff observed that while schwannomas appeared to be composed predominantly of Schwann cells, neurofibromas consisted of mainly perineurial cells. In addition, variable numbers of fibroblast-like cells and intermediate cells also have been reported in the 2 lesions. Whether these represent distinct cell types or variants of Schwann cells is still debatable. In an attempt to solve this controversy, the present study was undertaken to observe the morphology and the behaviour of these tumors in culture. These studies showed that all nerve sheath tumors are basically of Schwann cell origin and that intermediate cells and fibroblasts are variants of Schwann cell. Tissue culture studies done chiefly on schwannomas showed that the morphological features of schwannomas are preserved in 'in vitro culture' condition and therefore the difference between neurofibroma and schwannoma appears to be due to inherent differentiating property of the Schwann cells along with some environmental stimulus.

Growth and collagen synthesis of cultured neurofibroma fibroblasts

Cells from cutaneous neurofibromas of three patients with von Recklinghausen's disease and skin fibroblasts from four healthy adults were cultured. After two passages, DNA and collagen syntheses were determined by measuring incorporation of [3H] thymidine and [3H] proline respectively, and expressed as the values per unit DNA content. These values from neurofibroma cells were increased by 54% in DNA synthesis and 60% (p < 0.05) in nondialyzable hydroxyproline synthesis, suggesting that neurofibroma cells in culture even after several passages still possess those characteristics corresponding to their pathological features in vivo. Collagen synthesized by neurofibroma cells appears to be normal as judged by intracellular degradation rates and SDS-polyacrylamide gel electrophoresis.

Glycosaminoglycans in neurofibromas

Glycosaminoglycan (GAG) contents in neurofibromas (NFs) were examined to clarify how well they corresponded to their histological features. Eight cutaneous NFs and three plexiform NFs from five patients with Recklinghausen's (R) disease, two senile NFs and control dermis were subjected to the isolation of GAGs. The GAGs were then fractionated and quantitated with two-dimensional electrophoresis on cellulose acetate membranes. Dry weight/wet weight ratios of the NFs were lower than those of the controls; the plexiform NFs were the lowest. In these plexiform NFs, hyaluronic acid (HA) content was most increased and dermatan sulfate (DS) content most decreased, resulting in a marked decrease in the DS/HA ratio. Both cutaneous and senile NFs showed moderate decreases in DS content, increases in chondroitin sulfate and heparan sulfate contents, and slight increases in HA content, resulting in moderate decreases in the DS/HA ratio. Considering that cutaneous or senile NFs are relatively more fibrotic tumors than plexiform NFs, these differences in the GAGs between plexiform NFs and cutaneous or senile NFs appear to be consistent with the changes in GAGs previously described in physiological and pathological conditions such as fibrotic diseases. Thus these results suggest that studies of hereditary disorders like R disease might be useful for understanding the pathogenesis of so-called acquired diseases with unknown etiology.

Benign nerve sheath tumors: a light microscopic, electron microscopic and immunohistochemical study of 102 cases

One hundred and two cases of benign nerve sheath tumors (NSTs) were studied with a combined approach using routine light microscopy (LM), immunohistochemistry (IH) for myelin basic protein (MBP) and S-100 protein as well as transmission electron microscopy (TEM) with the aim of obtaining greater insight into the true nature of these neoplasms, and also to establish the importance of IH and TEM in their diagnosis. Myelin basic protein was not identified in any of these tumors, whereas S-100 protein was positive to a variable degree in both schwannomas and neurofibromas. TEM revealed that Schwann cells predominated in tumors which were strongly positive for S-100 protein and appeared as schwannomas by LM. However, neurofibromas showing a variable patchy positivity for S-100 were composed of an admixture of Schwann cells, fibroblast-like cells and intermediate cells considered to be modified Schwann cells. Perineurial cells in typical form were not seen. It is concluded that all NSTs are basically of Schwann cell origin and that the intermediate cells and fibroblast-like cells are variants of Schwann cells. The different morphological appearances and biological behaviour of schwannomas and neurofibromas may be related to some other factors like micro-environment or genetic predisposition. Further, both IH, especially for S-100 protein, and TEM play an important role in establishing their diagnosis.

Increased deposition of types III and V collagen in neurofibroma tissue from patients with von Recklinghausen disease

Collagen components in neurofibroma tissue from patients with von Recklinghausen disease were investigated, in comparison with those in normal skin and peripheral nerve tissue. Biochemical analysis of collagen isolated from the tissues by limited pepsin digestion indicated that the neurofibroma tissue contained type I collagen as the major constituent and increased amounts of types III and V collagen. The relative ratios of alpha 1(III)/alpha 1(I) and alpha 1(V) + alpha 2(V)/alpha 1(I) in the tissue were 0.87-0.92 and 0.16-0.17, respectively, while in normal skin, these ratios were 0.36-0.45 and less than 0.024, respectively. Amino acid analysis and circular dichroism studies of types I, III and V collagen purified from the tissue showed that these collagens were essentially the same as the corresponding types of collagen isolated from fetal human skin and placenta. The increased deposition of types III and V collagen suggested that alternation of collagen metabolism had occurred in the neurofibroma tissue.

Collagens in neurofibromas and neurofibroma cell cultures

Neurofibromas contain approximately 30-50% collagen of their lipid-free dry weight, which is about half of the value of skin but approximately twice that described for peripheral nerve endoneurium. Immunohistochemical stainings indicate that neurofibromas contain types I, III, IV, and V collagens and fibronectin. Most of the neurofibroma cells are type IV collagen and S-100 protein positive, which provides immunohistochemical evidence that neurofibromas are mostly composed of Schwann cell-like cells. The proteoglycan/collagen ratio is 4 to 10 times higher in the neurofibromas than in the surrounding dermal tissue. This would explain the typical soft consistency of the neurofibromas and may contribute to a favorable milieu for tumor growth. Pure fibroblastic cell cultures are obtained from neurofibromas after repeated passages. The cultured cells synthesized type I and III collagens and fibronectin, indicating that these cells are important in the production of the fibrous connective tissue proteins in neurofibromas.

Cell culture studies on neurofibromatosis (von Recklinghausen's disease). IV. Collagen synthesis

Comparative measurements of collagen synthesis as a portion of total protein synthesis were performed with fragments of peripheral neurofibromas, of skin adjacent to the tumors, and of unaffected skin from patients with neurofibromatosis (NF). No significant difference was found among these various samples. Collagen synthesis was also measured in cell cultures derived from peripheral neurofibromas of eight NF patients and from skin of ten healthy donors. No differences observed in the following respective parameters: dependence on the concentration of fetal calf serum; dependence on cell population density; portion of synthesized collagens in the culture medium and the cell layer. The ratios of synthesized collagen types III to type I, determined in five pairs of NF and control strains, vary within the same range.

Distribution of different collagen types and fibronectin in neurofibromatosis tumours

Collagen types I, III, IV and V and fibronectin were localized in neurofibromas from six patients with von Recklinghausen's neurofibromatosis (NF) using indirect immunofluorescence (IIF) and peroxidase anti-peroxidase (PAP) techniques. Type I and III collagens were abundantly and rather evenly present in the tumours and formed a continuous network, but were absent from the capillary endothelial walls and were sparse in the perineurium of the occasional nerve fascicles. The type III/type I + type III collagen ratio in neurofibromas varied from 17.4% to 37.3% when estimated with cyanogen bromide peptide analysis. Fibronectin was detected in areas where type I and III collagens were present but was most intensively stained in the vascular walls and perineurium. Type IV collagen was detected at the dermo-epidermal junction of the skin overlying the tumours, in the endothelial cells of the capillaries, the perineurium and endoneurium. Furthermore, in the tumourous stroma there was plenty of type IV collagen appearing as a discontinuous patchy pattern suggesting abundant basement membrane material associated with cells forming the tumours. Type V collagen distribution was very similar to that of type IV collagen.

Neurofibromatosis tumor and skin cells in culture. II. Structural proteins with special reference to the cytoskeletal and cell surface components

Structural proteins of cultured neurofibromatosis (NF) tumor and skin cells were studied with reference to control skin fibroblasts. In polyacrylamide gel electrophoresis (PAGE)/fluorography the banding patterns of the cell lysates were markedly similar. NF tumor cells, however, produced a 60 kD band with a stronger and a 48 kD band with a lighter protein staining and metabolic labeling intensity. Furthermore, skin cells were also characterized by a 26 kD protein and the tumor cells by a 22 kD protein with high metabolic labeling intensity. Neuraminidase/galactose oxidase/NaB3H4-labeled NF skin and control skin cells possessed a 220 kD protein that was less intensively labeled in the tumor cells. The banding pattern of the skin cells was also characterized by a protein with slightly lower molecular weight (86 kD) than that of the tumor cell lysates (90 kD). In all cell lines studied indirect immunofluorescence stainings revealed bright arrays of vimentin type intermediary filaments but no desmin, cytokeratin, glial fibrillary acidic protein (GFAP), or neurofilament proteins. NF skin and control skin cells possessed well developed actin-containing bundles of microfilaments, while those of the tumor cells lacked a typical stress-fiber organization. The general morphology of the tumor cell cultures was also irregular. Transmission electron microscopy revealed no basic differences in the structure of intermediary filaments or microfilaments. The present data provide basic knowledge of neurofibromatosis skin and tumor cells and demonstrate that cultured cells originating from neurofibromas are defective in both their intracellular and extracellular organization.

Neurofibromatosis tumor and skin cells in culture

Skin fibroblasts and tumor cells were cultured from four patients with peripheral von Recklinghausen's neurofibromatosis (NF). The cell type enriched in culture from the tumors carried the fibroblastic Thy 1.1. cell surface antigen and produced fibronectin, like fibroblasts from skin of NF-patients or from control persons. In electron micrographs the NF tumor and NF skin cells were similar to the control skin fibroblasts; elongated in shape, contained tubular mitochondria, variable amounts of granular endoplasmic reticulum, numerous lysosomal inclusion bodies and collections of 5 nm filaments. Trypsinized cells were fractionated with centrifugation in a Percoll density gradient. All cell lines produced only one sharp band of viable cells at the buoyant density of 1.03. Compared with the NF skin or control skin fibroblasts the NF tumor cells, however, produced a less well organized peri- and extracellular matrix estimated from fibronectin fluorescence. The nuclear sizes were measured from photographs of the cultures. The nuclei of all four tumor cell lines were larger than those of the skin fibroblasts of the corresponding patients. Neurofibromatosis tumor cells thus resemble skin fibroblasts in their density and in some ultrastructural properties but are different in their growth pattern and synthetic functions.